Provider Demographics
NPI:1487841110
Name:FAKIOGLU, ESRA
Entity Type:Individual
Prefix:DR
First Name:ESRA
Middle Name:
Last Name:FAKIOGLU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2066 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3960
Mailing Address - Country:US
Mailing Address - Phone:718-982-9001
Mailing Address - Fax:718-982-9008
Practice Address - Street 1:2066 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3960
Practice Address - Country:US
Practice Address - Phone:718-982-9001
Practice Address - Fax:718-982-9008
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0029112080P0208X
NY266365208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics